Case 39221

Presentation of CaseA forty-three-year-old single housewife was referred to this hospital wich a previous diagnosis of pemphigus vulgaris.The patient was well until about two years before admission, when she first noted a spot of alopecia with crusting on the scalp and an ulcerative, painful lesion in the oral cavity. She consulted a number of physicians, who prescribed a variety of medications, but none gave her relief. The oral lesions cleared up within a month but later returned, and a diagnosis of pemphigus vulgaris was made.Seventeen months before admission she had been treated with ACTH (adrenocorticotrophic hormone), 200 . . .